CORONAVIRUS

[acaie]

A bit surprised that there has been no comment on this thread about the BBC report on PPE and Donald Trumps comments about disinfectant.

[Rod1883]

I think everyone is getting weary of the constant petty sniping by much of the media - the BBC included.

I'll bite on the gloves issue - as many of us know from having similar in our garages, single use multi packs of gloves are counted individually on the box they come in - usually multiple '00's of gloves in a box. They will be stocked as these boxes of singles (and often used /replaced singly) and so inventory records will be the same. For someone to equate that to pairs of gloves would require the effort of identifying all single gloves in any shipment of multi-item PPE and divide that figure by 2. Not productive use of anyone's time.

It seems to me that we will never know what might have been if this that or the other had been done, as even with hindsight - it is not clear what the result of a different course of action might have been.

[Misfit]

 I have seen much on the media, about what’s not been done and when promoting Captain Tom, I’d like to applaud, Captain Tom for his amazing fund raising for the NHS staff. It has been unprecedented for an individual to have generated this incredible amount that is still rising.

I do not want to take anything away from his achievements on behave of the NHS workers. We also have many Hospices that cares for terminally ill people towards the end of life. Who would otherwise likely need to be in hospital.

My concern is that unlike the NHS which is government funded, many of these are charities, reliant mainly on fund raising, money and items of clothing and household goods donated, which are sold in their shops. 

They are going through a real tough time at the moment while their shops and cafeterias are mainly staffed by volunteers these are now closed as are many other premises where there donation buckets are situated.

Like Hospital and care homes these hospice charities have staff that look after patients, in their case the terminally ill, offering end of life care. They have admin and other supportive staff too and some of these important and valuable staff members are now at risk of losing their jobs as funds raising and reserves are seriously diminishing. Some already reliant on existing borrowing, and are attempting to maintain interest payments and rents on their properties for the privilege. 

We need these important Hospices to survive and they need help, Captain Tom fundraising took off when the media especially Television took up his case. 

These are important charities and I’d like to see the media’s  efforts look to supporting those that look after the very sick end of life patients and promote all fundraising on their behalf instead of calling the government to account, there is time for that when we our out of the woods,  let the government give us necessary updates and spend their time sorting things, than answering the same questions time and time again put to them by experts and journalists.

m

Edited July 27, 2020 by Misfit

[barkerwilliams]

PPE ramblings (again).

Any once else listen to Radio 4 "More or Less" on 22nd at nine? In that program they show that statistically the percentage of NHS worker Covid deaths are similar to percentage of working age deaths in the UK from Covid. Not trying to make a point just interesting that NHS workers seem not to have an excessive risk - I would have guessed that they would have, however I also note that have not been many cases reported of care home workers with Covid complications or mortality, difficult to get any reliable stats though, just news reports that may be incorrect.

And - genuine question,  why is it governments responsibility to supply PPE to the NHS and not the NHS purchasing managers to procure their own supplies of all items used by the NHS?

Alan

 

 

 

 

[Peter Cobbold]

I'm worried at the difficulty of Boris maintaining UK lockdown when Greece and Portugal are already relaxing theirs. But these are sun-soaked countries...you get my drift. Worse still would be if SAGE dont realise the significance of sun and decide its safe for us to un-lock because Greeks and Portugese do well.

Peter

[rog1]

Don't ignore the statement from Matt Hancock today, he's apparently "moving heaven and earth" probably easier to keep both of them in an empty nightingale hospital somewhere.

Jeez!

[John Morrison]

11 hours ago, Derek Hurford said:

 I have seen much on the media, about what’s not been done and when promoting Captain Tom, I’d like to applaud, Captain Tom for his amazing fund raising for the NHS staff. It has been unprecedented for an individual to have generated this incredible amount that is still rising.

I do not want to take anything away from his achievements on behave of the NHS workers. We also have many Hospices that cares for terminally ill people towards the end of life. Who would otherwise likely need to be in hospital.

My concern is that unlike the NHS which is government funded, many of these are charities, reliant mainly on fund raising, money and items of clothing and household goods donated, which are sold in their shops. 

They are going through a real tough time at the moment while their shops and cafeterias are mainly staffed by volunteers these are now closed as are many other premises where there donation buckets are situated.

Like Hospital and care homes these hospice charities have staff that look after patients, in their case the terminally ill, offering end of life care. They have admin and other supportive staff too and some of these important and valuable staff members are now at risk of losing their jobs as funds raising and reserves are seriously diminishing. Some already reliant on existing borrowing, and are attempting to maintain interest payments and rents on their properties for the privilege. 

We need these important Hospices to survive and they need help, Captain Tom fundraising took off when the media especially Television took up his case. 

These are important charities and I’d like to see the media’s  efforts look to supporting those that look after the very sick end of life patients and promote all fundraising on their behalf instead of calling the government to account, there is time for that when we our out of the woods,  let the government give us necessary updates and spend their time sorting things, than answering the same questions time and time again put to them by experts and journalists.

Wholeheartedly agree Derek.

Would add that I thought moving Covid 19 patients from NHS hospitals to Nightingales, staff permitting, and allowing the main stream hospitals to start the

treatment of very ill, non covid patients was also the right move.

John.

 

[JohnG]

36 minutes ago, John Morrison said:

Wholeheartedly agree Derek.

Would add that I thought moving Covid 19 patients from NHS hospitals to Nightingales, staff permitting, and allowing the main stream hospitals to start the

treatment of very ill, non covid patients was also the right move.

John.

 

 

Why haven't the new facilities been used as isolation hospitals . . . Up to 4000 bed in London alone.

Then, at least some of our hospitals would have remained covid free

[Rod1883]

45 minutes ago, wjgco said:

 

Why haven't the new facilities been used as isolation hospitals . . . Up to 4000 bed in London alone.

Then, at least some of our hospitals would have remained covid free

I imagine all things take time. The facilities have been created in a near record period but until they were proved to be achievable the next steps couldn't be assumed? Perhaps there is now a strategy to do as you say - or vice versa.

I would expect some of these Nightingales to be retained in some form once this is over/has diminished to a low level for the next big crisis....

[iain]

Nightingales are a classic case of robing Peter to pay Paul. There are a finite number of trained Intensivists.......re training of staff from non ITU backgrounds has been massive to try and cope as it is.

 

 

[Mick Forey]

The other element that the government is being criticised for is not providing enough PPE to care homes. The majority of care homes are private business, run to make money. They are legally responsible for their own staff and residents health and safety. They buy their own PPE along with all other essential supplies and were given the same warning as the general public, NHS procurement organisation and the government when this all kicked off in China. Did they order enough PPE in January, February and March? All the charts right from day one showed that the age group with the highest risk was the over 80s. Where are many of the over '80s?

Mick

 

[stillp]

On the BBC News web site: https://www.bbc.co.uk/news/health-52371688

Pete

[barkerwilliams]

Mick,

Wholeheartedly agree. At many of the briefings though Matt Hancock has used the term "we" when relating to sourcing PPE presumably inclusive of government and I do not understand why. Surely the approach should be to hold care homes to account. Unfortunately though it is part of our just-in-time procurement for everything, I can understand the manufacturers having the capacity to produce a months worth of whatever each month in line with orders, and then demand rises 100 or 1000 fold over a few weeks. I cannot see any reason why manufacturers would, or should be expected to be able to meet such demand whilst their products are normally being sourced at rock-bottom prices with little margin to invest in redundant, mothballed equipment.

I still do not comprehend why, with apparently so little PPE available, the care home and hospital staff are not falling victim to Covid-19 more often than they appear to be. (thankfully)

Alan

[Bleednipple]

11 hours ago, barkerwilliams said:

Mick,

Wholeheartedly agree. At many of the briefings though Matt Hancock has used the term "we" when relating to sourcing PPE presumably inclusive of government and I do not understand why. Surely the approach should be to hold care homes to account. Unfortunately though it is part of our just-in-time procurement for everything, I can understand the manufacturers having the capacity to produce a months worth of whatever each month in line with orders, and then demand rises 100 or 1000 fold over a few weeks. I cannot see any reason why manufacturers would, or should be expected to be able to meet such demand whilst their products are normally being sourced at rock-bottom prices with little margin to invest in redundant, mothballed equipment.

I still do not comprehend why, with apparently so little PPE available, the care home and hospital staff are not falling victim to Covid-19 more often than they appear to be. (thankfully)

Alan

When you say "fall victim" do you mean die? If so, it looks as though C19 confirmed fatalities among NHS staff have - so far - been about the average for their demographic. I haven't seen any data for care home staff. But there have been reports, anecdotally, of high levels of staff absences in both sectors, although until recently due to the lack of testing we can't attribute that as C19 or non-C19 illness. So I guess it does remain unclear whether unavailability of PPE has had a big consequence for levels of staff's C19 contraction, or resulted in any avoidable deaths to them.

However the point of having the recommended types of PPE available is to minimise risks of staff cross-infecting extremely vulnerable care home residents, not simply to protect the staff. 

Regarding accountability for care home availability of PPE, I don't personally think pointing the finger at private businesses - care homes - gets us very far. Yes, in a perfect world they would all have had business continuity plans that included stock holding of kit for the worst case scenario of lengthy duration and on the assumption that marketplace replenishment would become practically unfeasible once the emergency was running. But - the government surely ultimately has responsibility for minimising risks to life in a major emergency. A few weeks ago I thought it would be illuminating to read the government's own pandemic flu plan. It says that the consumables stockpile would be used to enable an initial surge of high demand items to the NHS. No mention of social care institutions. Make of that what you will. And did the government's own ongoing inspection regime for social care establishments make it a requirement for them to hold very large stocks of PPE? 

But we're going to have to wait for the eventual public enquiry to understand it all.

Nigel

[Misfit]

Care homes have been an important element for providing care for the elderly, unlike in the past when families were responsible as they are still I n Spain and France where it’s a requirement.

I accept that some care homes have been well compensated over the years, my own Grandfather and his wife were paying £45,000 per annum years ago, they have responsibility for their occupants. 

The lack of ability to procure PPE, is not entirely the fault of individual care homes. The NHS has had priority, everyone all over the world have been purchasing it in such a short period, that has had an effect too. I’m sure we Initially considered an Asia problem, I know I did  especially in the very early days before the world was so quickly effected and prior to realising the amount of PPE needed could have been envisaged.

It’s true no business wants to hold stock or spend money on something they are unlikely to need when stocks seemed plentiful and accessible or at least that seemed to be the case.

Government do have responsibility to their citizens and they can procure PPE easier than individual businesses therefore they should try and get it to the right places. However it’s individual businesses that are delivering the care for which they are paid.  

We were told to wash our hands but nobody said that wiping down work surfaces with disinfectant or cleaning toilets was important. That was a question or something similar by a journalist to the government representative on Tuesday. 

Thats frightening, what have we become a nation that needs to be told everything, that’s unless of course we are told something that we don’t want then we have rights. 

Nothing comes into my house without a process, cardboard plastic, tins, fresh produce all have process. I don’t know why so many people have caught Covid 19 in care homes, if the right process is in place, but it’s not just down to PPE. 
m

Edited July 27, 2020 by Misfit

[Bleednipple]

13 minutes ago, Derek Hurford said:

It’s true no business wants to hold stock or spend money on something they are unlikely to need when stocks seemed plentiful and accessible or at least that seemed to be the case.

I agree with your post Derek and particularly with this bit. The same applies to governments. As one civil emergencies expert said recently, it's hard to get politicians to "think about something they don't want to think about, and spend money they don't want to spend, on something they don't think is going to happen".

Yet at the same time, we as individuals are fully bought into the idea of spending quite large sums, often a big chunk of our household budgets, every single year insuring our houses against being badly flooded or burnt down, events which actually are extremely unlikely.

On the other hand, a novel virus pandemic was not extremely unlikely. It was acknowledged in the government's own risk register as very likely, and in fact the number one threat both in terms of likelihood and potential impact (750,000 deaths assumed). And actuaries knew it: "From a purely probability theoretical point of view, the probability for a pandemic to incur in any given ten years is roughly 30%."  (Actuarial reflections on pandemic risk and its consequences, 2006).

Meanwhile we spend £35 billion every single year on defence. Have we got that balance right?

Nigel

[peejay4A]

To the best of my knowledge the NHS supply chain is a private company wholly owned by the Government.  So it is Hancock's responsibility.

[barkerwilliams]

"....When you say "fall victim" do you mean die?..."

Not exclusively, I mean both die and fall seriously ill a'la Boris Johnson. I presume that whilst herd immunity is desirable but impracticable for the whole country,  immunity within the NHS & care home staff is fairly likely with the exposure I expect they receive not only from the patients but from the entire building's surfaces - I can see wiping down surfaces may well sterilise them 100% but I have been unable to find any data on the persistence of such cleaning materials, i.e. perhaps after a few minutes of cleaning airborne virus starts to settle and contaminate surfaces once more. 

I can see PPE, gowns and gloves  could protect cross contamination between patients but  would need to be replaced between each patient and different room visited. I can well imagine that that would required at least 40 or more changes of gowns and gloves each day. Interesting the approach by the care home in the Midlands who created an isolated room and moved thirteen elderly and dementia residents in together and all survived; wonderful result. Cross contamination between patients was not an issue.

I also interested in the speed that the Virus managed to infect care home when there were so few cases confirmed in the UK. Yes some staff might move between care homes but the infection almost targeted care homes, at least the result of infection is more apparent. Unless of course the infection is far wider spread in the general population than reported, perhaps many of us have unknowingly already had the infection.

I understand defence spending is about £50 billion annually, and NHS is about £160 Billion.

Alan

US Study into Vit D  https://www.news-medical.net/news/20200429/Low-levels-of-vitamin-D-may-be-linked-to-severe-COVID-19.aspx

 

Edited April 30, 2020 by barkerwilliams

[Misfit]

31 minutes ago, Bleednipple said:

Meanwhile we spend £35 billion every single year on defence. Have we got that balance right?

Nigel

Possibly not, but if we do need to defend our country or way of life and or the way of life of others. I am absolutely confident, the Government will be accused of lack of investment into all branches of the military and the opposition and media will be relentless.

[Peter Cobbold]

1 hour ago, barkerwilliams said:

"....When you say "fall victim" do you mean die?..."

Not exclusively, I mean both die and fall seriously ill a'la Boris Johnson. I presume that whilst herd immunity is desirable but impracticable for the whole country,  immunity within the NHS & care home staff is fairly likely with the exposure I expect they receive not only from the patients but from the entire building's surfaces - I can see wiping down surfaces may well sterilise them 100% but I have been unable to find any data on the persistence of such cleaning materials, i.e. perhaps after a few minutes of cleaning airborne virus starts to settle and contaminate surfaces once more. 

I can see PPE, gowns and gloves  could protect cross contamination between patients but  would need to be replaced between each patient and different room visited. I can well imagine that that would required at least 40 or more changes of gowns and gloves each day. Interesting the approach by the care home in the Midlands who created an isolated room and moved thirteen elderly and dementia residents in together and all survived; wonderful result. Cross contamination between patients was not an issue.

I also interested in the speed that the Virus managed to infect care home when there were so few cases confirmed in the UK. Yes some staff might move between care homes but the infection almost targeted care homes, at least the result of infection is more apparent. Unless of course the infection is far wider spread in the general population than reported, perhaps many of us have unknowingly already had the infection.

I understand defence spending is about £50 billion annually, and NHS is about £160 Billion.

Alan

US Study into Vit D  https://www.news-medical.net/news/20200429/Low-levels-of-vitamin-D-may-be-linked-to-severe-COVID-19.aspx

 

Alan, Tks for that link. 

Here's a scottish GP  who takes 4000 IU pd

https://drmalcolmkendrick.org/2020/04/28/covid-update-focus-on-vitamin-d/

Peter

 

[foster461]

46 minutes ago, Peter Cobbold said:

Alan, Tks for that link. 

Here's a scottish GP  who takes 4000 IU pd

https://drmalcolmkendrick.org/2020/04/28/covid-update-focus-on-vitamin-d/

Peter

 

Nice one Peter. We have been hearing for a while now that many of the people that die in the ICU are not dying of ARDS. They are getting blood clots, strokes and congestive heart failure (even young people, even small kids and babies). The endothelial cells in arteries etc are getting attacked by the virus. Too bad they dont test D levels in every person that gets infected. We would learn a lot from studying outcomes vs Vit D levels.

[iain]

Renal failure is being increasingly seen with C-19

[RobH]

More similar papers:

https://www.medrxiv.org/content/10.1101/2020.04.24.20075838v1. (Vitamin D Insufficiency is Prevalent in Severe COVID-19)

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484.  (Vitamin D Supplementation Could Possibly Improve Clinical Outcomes....)

Quote from the first:

Strikingly, 100% of ICU patients less than 75 years old had VDI. Coagulopathy was present in 62.5% of ICU COVID-19 patients, and 92.3% were lymphocytopenic. Conclusions: VDI is highly prevalent in severe COVID-19 patients.

[foster461]

I think we are going to find that covid19 is a vascular disease and the lungs are just the way in.

[john.r.davies]

Such complications of severe respiratory failure are not exclusive to Covid, nor are they indications of a specific effect of that infection.    

Quote: "Acute respiratory failure is frequently fatal. Attempts to decrease mortality must include attention to pulmonary and extrapulmonary complications. Pulmonary complications include pulmonary emboli, [blood clots in the lungs]  barotrauma, fibrosis, and pneumonia. Swan-Ganz catheters, tracheal intubation, and mechanical ventilation can also result in pulmonary complications. Extra-pulmonary complications such as gastrointestinal hemorrhage, renal failure, infection, and thrombocytopenia may increase mortality. Early diagnosis, aggressive treatment, and prophylaxis of complications should increase survival."   See: https://www.ncbi.nlm.nih.gov/pubmed/6405105   You will note that that paper is from 1983.         Blood clots, strokes, congestive heart failure and even endarteritis are complications of ARDS, not specific to Covid.

What do seem to be features of the disease are the wide variation of  its wide impact, presumabky ona genetic basis and causing more serious disease in people of African and Asian origin,  and the relatively high incidence of 'cytokine storm', a pathological immune overreaction by the body, that can lead to rapid multisystem failure.    Also, in the last few days, warnings have been issued to watch out for the last in even young children, on whom otherwise Covid has a relatively low impact.

The Covid Symptom Tracker project has recently found more on how genetics affect the response to Covid, by studying twins, both identical (and so with the same genome) and non-identical (as different as any siblings).  "The analysis showed that roughly half of the difference in symptoms between people can be explained by underlying variations in their genes, while the rest is due to other factors such as amount of viral exposure (viral load), underlying health conditions, environment and lifestyle."   See: https://covid.joinzoe.com/post/genetics-covid

John

PS I fear that the Covid Tracket site misspoke itself.     "Viral Load" is the amount of virus in the body, organ or tissue being studied.     They should have referred to "Infecting Load", the number of viral particles that the body receives in the initial exposure.

 

Edited April 30, 2020 by john.r.davies